تقييم الصحة - نظام الجلد

Study Notes

Integumentary System Components: Skin, hair, and nails.
Assessment Techniques: Inspection and palpation are the only techniques used to assess the Integumentary System.
Skin Layers: Epidermis, dermis, and subcutaneous tissue.
Skin Functions: Sensation, heat regulation, absorption, protection, excretion, secretion, and vitamin D production.

Overall Appearance: Skin assessment begins by observing the overall appearance of the skin.
Inspection and Palpation: Examine the skin area by area, paying attention to color, moisture, texture, turgor, and temperature.
Color: Check for uniformity of color and look for bruising, cyanosis, pallor, or erythema.

Cyanosis: Look for a dull, dark color in the conjunctivae, palms, soles, buccal mucosa, and tongue.
Edema: Check the area for decreased color and assess for tightness.
Erythema: Palpate the area to check for warmth.
Jaundice: Examine sclerae and hard palate in natural light for a yellow color.
Pallor: Check sclerae, conjunctiva, buccal mucosa, lips, tongue, nails, palms, and soles for an ashen color.

Petechiae: Check areas with less pigmentation (such as the abdomen) for tiny purplish-red dots.
Purpura: Hemorrhage into the skin due to low platelet count or liver dysfunction.
Ecchymosis: Discoloration of the skin (black and blue marks) due to trauma.
Vitiligo and Albinism: Conditions with insufficient melanin production, causing skin depigmentation .

Changing Moles/Navies: Assess moles for asymmetry, border irregularity, color variation, diameter greater than 1/4 inch, and evolution (changes over time).

Skin Moisture: Skin should be relatively dry with a minimal amount of perspiration.

Skin Texture and Mobility: Inspect and palpate the skin's texture, thickness, and mobility. It should look smooth and intact.
Turgor Assessment: Gently squeeze the skin, noting how quickly it returns to its original shape. Normal turgor means quick return; poor turgor means slow return or tented position.

Palpation: Palpate the skin bilaterally using the dorsal surface of the hands and fingers to assess temperature. Warm skin suggests normal circulation; cool skin may indicate an underlying disorder.

Lesion Classification: Primary/secondary, solid/fluid-filled.
Lesion Characteristics: Symmetry, borders, color, configuration, diameter, and drainage.
Lesion Shapes: Discoid, annular, target/bull's eye.

Psoriasis: Chronic skin disease with epidermal thickening, symmetrical plaques with silvery scales, commonly on scalp, elbows, and knees.
Herpes Zoster: Caused by varicella-zoster virus; appears as clustered vesicles or crusted lesions along a nerve root. Commonly unilateral and on the trunk.
Chickenpox: Common childhood illness causing itchy rash and red spots/blisters (pox).
Scabies: Caused by tiny mites burrowing under the skin; lesions are itchy and appear in lines on the skin (common locations: between fingers, elbows, knees, groin, abdomen, perianal).

Definition: Localized areas of skin breakdown resulting from prolonged pressure.
Development: Necrotic tissue develops due to diminished vascular supply to the area.
Staging: Staging reflects the anatomic depth of the exposed tissue.

Nail Structure: Formed from keratinized epidermal cells.
Assessment: Color, shape, consistency, and contour are assessed.
Common Abnormalities: Clubbed fingers, splinter hemorrhages, Muehrcke's lines.